Students’ Information update

Identification Code*

Grade*

Class*

Student Name 1A*

Student Name 1E*

Student Name 1I*

Student Name 1S*

Student Name 1L*

Student Name 2A*

Student Name 2E*

Student Name 2I*

Student Name 2L*

Student Name 2S*

Student Name 3A*

Student Name 3E*

Student Name 3I*

Student Name 3L*

Student Name 3S*

Student Name 4A*

Student Name 4E*

Student Name 4I*

Student Name 4S*

Student Name 5A*

Student Name 5E*

Student Name 5I*

Student Name 5S*

Student Name 6A*

Student Name 6E*

Student Name 6I*

Student Name 6S*

Student Name 7A*

Student Name 7E*

Student Name 7I*

Student Name 7S*

Student Name 8A*

Student Name 8E*

Student Name 8I*

Student Name 8S*

Student Name 9A*

Student Name 9E*

Student Name 9I*

Student Name 9L*

Student Name 9S*

Student Name 10A*

Student Name 10E*

Student Name 10I*

Student Name 10L*

Student Name 10N*

Student Name 10S*

Student Name 11A*

Student Name 11E*

Student Name 11I*

Student Name 11L*

Student Name 11N*

Student Name 11S*

Student Name 12A*

Student Name 12E*

Student Name 12I*

Student Name 12S*

Choose a language to fill the student's medical data*

English
Arabic

Does the student complain of any chronic or congenital disease?*

Yes
No

هل يعاني الطالب من مرض مزمن او عيب خلقي او مرض يتكرر حدوثه؟*

Yes
No

If yes, mention the name of the disease, symptoms and medicine used?

اذا كان الاختيار نعم, يرجى ذكر اسم المرض وأعراضه والعلاج المُستخدم

Name the contraindicated medicines if any.

اذا كان هناك اي ادوية يمنع الطالب من استخدامها برجاء ذكر اسمها

Name the previous operations if there is any history.

برجاء ذكر اي عمليات جراحية سابقة

Parent or legal guardian of the student*

Hereby, I give permission to the school doctor to give adequate medication when needed.*

اسمح لطبيب المدرسة اعطاء ابني/ ابنتي الدواء المناسب اذا لزم الامر*

Consent*

I agree to the terms below.

I do hereby consent that all the information sent in the medical form is correct and complete and I will not send my child to school in case
1. He/ She complains of any symptoms of COVID-19
• Fever
• Cough
• Loss of taste & smell
• Shortness of breath
• Headache
• Sore throat
• Runny nose
• Nasal obstruction
• Diarrhea
• Vomiting.
2. He/ She is a contact of COVID-19 case.
3. He / She is under medication for treatment of any acute medical condition.
I also consent that my child will not return back to school in case he/ she is sick except after complete recovery with all documents needed by the school and after checkup at the school clinic.

Consent*

اقر بالموافقة على الشروط التالية

ان جميع المعلومات المسجلة بالحالة الصحية لابني /ابنتي صحيحة و كاملة و انني لن ارسل ابني الى المدرسة في حالة :
1- ظهور اي عرض من اعراض كوفيد 19:
• ارتفاع في درجة الحرارة
• سعال
• فقد حاستي الشم و التذوق
• ضيق في التنفس
• صداع
• انسداد او سيلان في الانف
• اسهال
• قيء
2- اذا كان مخالط لاي حالة ايجابية لكوفيد 19
3- اذا كان مريض و يعالج من اي مشكلة صحية حادة
و اقر ايضا انني لن ارسل ابني / ابنتي الى المدرسة في حالة مرضه الا بعد الشفاء التام و احضار الاوراق التي تفيد ذلك الى المدرسة و بعد الكشف عليه في عيادة المدرسة

Student data status*

I don't need to update the data sent by email
I need to update some data

ONLY Fill the fields you need to update

Date of birth

National ID (From Certificate of Birth)

Address in details

Street Address Address Line 2 City

Transportation Type

Bus
Gate

Home phone

Father ID

Father's Mobile phone

Father's Occupation

Father's Email

Enter Email Confirm Email

Mother's Name

Mother's Mobile phone

Mother's Occupation

Mother's Email

Enter Email Confirm Email

Emergency Contacts

Name	Tel	Relationship

Nasr City

New Cairo

6th October

El Shorouk

Roots & Wings preschool

ELS – Nasr City

ELS – New Cairo School

EAIS – New Cairo

EBIS – New Cairo

ELS – 6th october

EAIS – 6th of october

EBIS – 6th of october

EAIS – El Shorouk

EBIS – El Shorouk

Students’ Information update

ONLY Fill the fields you need to update